6
History of Present Illness A few days later, (+) weakness of R LE, admitted to LH; CXR, holoab UTZ, cranial CT scan and labs done were allegedly normal discharged and prescribed with unrecalled meds but stopped due to allergy (rashes on both thighs)

8
History of Present Illness 5 mos PTA, consult was done at V. Luna A> t/c Decompression sickness P> recompression x 10 session However, pt opted to discontinue after the third session due to fear of dyspnea inside the vessel

33
Inflammatory  Transverse myelitis  Myelopathic process of unknown cause from inflammation of spinal cord  May start as pain or paresthesia in localized body parts and can progress to paresis and plegia  Multiple sclerosis  Immune-mediated demyelinating disorder which may also initially present as pain and progress to weakness of limbs  Systemic lupus erythematosus  Autoimmune illness which usually presents with other systemic symptoms such as pleuritis, hematologic, immunologic or neurologic alterations, and dermatologic signs

35
Vertebral Disease  Vertebral disk prolapse  Usually due to a tear in the outer fibrous ring (annulus fibrosus)  May initially present as pain of extremities and progress to paresis depending on the level of herniation  Spondylosis  Degenerative odteoarthritis of the spine  Presents as pain, paresthesia or muscle weakness  Paget’s disease  Due to excessive breakdown and formation of bone, followed by disorganized bone remodeling  Causes bone pain but very rarely presents as tetraparesis

36
Others  Hereditary spastic paraparesis  characterized by insidiously progressive bilateral lower-extremity weakness and spasticity, with family history of similarly affected individuals  may be transmitted in an autosomal dominant, autosomal recessive, or X-linked recessive manner  Degenerative motor neuron disease  Usually presents in the 6 th -7 th decades of life  heterogeneous group of neurologic diseases characterized by progressive degeneration of upper and lower motor neurons  Usually presents with weakness, atrophy, fasciculations, and hypo/hyperreflexia

37
Others  Decompression syndrome  caused by intravascular or extravascular bubbles that are formed as a result of reduction in environmental pressure  can occur in divers, compressed air workers, aviators, and astronauts  manifestations range from itching and minor pain to neurological symptoms, cardiac collapse, and death  Presents acutely

39
Course in the Wards  Upon Ward admission: - noted (+) flexor spasm 1-3x/hr upon movement - able to tolerate sitting > 1 hr. during OT - fair sitting balance unsupported but cannot be totally challenged - still dependent in transition with sitting and transfer from bed - able to eat his dinner, can sit with brace on, independent with setup

54
History  Presentation depends on:  Stage of disease  Site  Presence of complications such as neurologic deficits, abscesses, or sinus tracts  On diagnosis, already with the disease for 3-4 mos.  Back pain- earliest and most common symptom, can be spinal or radicular  Constitutional symptoms (fever and weight loss)

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Long-term Goals  To maintain socially acceptable bladder and fecal continence  To prevent possible complications of neurogenic bladder and bowel  To prevent and treat accordingly the complications that may arise from the thoracic- level SCI  To minimize the functional limitations and allow the patient to complete ADLs independently or with assistive equipment

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Management Goals  To prevent urinary tract infections and other long-term urologic sequelae  To maintain a socially acceptable bladder continence  by developing and implementing a bladder management program that will allow patient to reintegrate back into the community

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Heterotopic Ossification (HO)  Development of ectopic bone within soft tissues surrounding the joints  Often seen in the first 6 months post-injury  Incidence: 20-30%  Common areas : Hip > Knee > Shoulder > Elbow  Etiology is still unclear but may be due to metabolic, biochemical and circulatory factors  Presentation:  Heat and swelling over the joints  Decrease in ROM  Fever